Background and Objectives: Assisted living (AL) residents with dementia commonly exhibit behavioural expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the "ABC" model of antecedents, behaviours, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. Research Design...
(Edited publisher abstract)
Background and Objectives: Assisted living (AL) residents with dementia commonly exhibit behavioural expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the "ABC" model of antecedents, behaviours, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. Research Design and Methods: A convergent, mixed methods design was used in a study of health care supervisors from 250 AL communities in 7 states who reported 366 cases of resident BEs (one successful and one unsuccessful case). Qualitative analysis identified antecedents, BEs, staff responses, resident outcomes, and disposition (aging in place or discharge). Content analysis identified themes and compared case types. Descriptive statistics examined organizational characteristics associated with identifying antecedents. Results: One quarter of cases recognized antecedents; slightly more were identified in successful (28%) compared to unsuccessful cases (20%); staff in dementia-only and smaller communities identified antecedents more often. Combativeness and anxiety were the most frequently reported BEs. The majority of both types of cases reported staff responses. Medication management was enacted as a response in 40% of cases compared to psychiatric assessment in 33% of cases. Discussion and Implications: Staff training is indicated to increase AL staff recognition of antecedents; doing so might reduce the use of antipsychotic medications. Psychiatric assessment plays an important role in dementia care in AL and warrants further examination. Results could be helpful for applied behavioural researchers interested in developing ways to improve the identification of antecedents of BEs of persons with dementia.
(Edited publisher abstract)
Journal of Gerontological Nursing, 48(1), 2022, pp.35-41.
Publisher:
Healio
The purpose of the current pilot study was to determine the impact of an ambient activity technology, ABBY, on responsive behavior and family visiting in a long-term care (LTC) home. We were also interested in family and staff perceptions of the technology. A mixed methods research study was conducted over a 6-month period and data were collected using standardized measures and focus groups. Although no significant differences were noted in responsive resident behaviours, focus group data showed the ABBY enriched the care environment and provided additional opportunities for families and staff to engage residents. Although the introduction of a new technology can create challenges for staff, with time, these challenges can be overcome.
(Edited publisher abstract)
The purpose of the current pilot study was to determine the impact of an ambient activity technology, ABBY, on responsive behavior and family visiting in a long-term care (LTC) home. We were also interested in family and staff perceptions of the technology. A mixed methods research study was conducted over a 6-month period and data were collected using standardized measures and focus groups. Although no significant differences were noted in responsive resident behaviours, focus group data showed the ABBY enriched the care environment and provided additional opportunities for families and staff to engage residents. Although the introduction of a new technology can create challenges for staff, with time, these challenges can be overcome.
(Edited publisher abstract)
Subject terms:
residential care, family relations, carer views, staff views, digital technology, behaviour, participation, assistive technology, dementia, behaviour problems;
This article reports on a community-based psychosocial intervention for carers that has led to much lower level of caregiver distress. High rates of behaviour that challenge present in people with dementia who live at home and can result in higher levels of stress, depression and anxiety for carers. The study reported here involved 34 family carers in the north east of England. The intervention
(Edited publisher abstract)
This article reports on a community-based psychosocial intervention for carers that has led to much lower level of caregiver distress. High rates of behaviour that challenge present in people with dementia who live at home and can result in higher levels of stress, depression and anxiety for carers. The study reported here involved 34 family carers in the north east of England. The intervention consisted of a three stage process delivered over 12 sessions. Stage 1 involved assessing information surrounding behaviours that challenge. Stage two involved working collaboratively with the home carer to develop psychosocial strategies to cope with behaviours. Stage three is about evaluating the efficacy of psychosocial strategies collaboratively and implementing these in a care plan.
The results reported in this paper indicate that caregiver distress scores decreased following the home care intervention. This study contributes to evidence of the necessity of psychosocial interventions to maintain the mental health of carers at home.
(Edited publisher abstract)
Dementia: the International Journal of Social Research and Practice, 19(3), 2020, p.590–605.
Publisher:
Sage
Background and objectives: Behavioral and psychological symptoms of dementia are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviours have implications for both care partners’ well-being. This study used in-depth focus group data to examine family caregivers’ strategies for managing behavioural and psychological symptoms of dementia. Design...
(Edited publisher abstract)
Background and objectives: Behavioral and psychological symptoms of dementia are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviours have implications for both care partners’ well-being. This study used in-depth focus group data to examine family caregivers’ strategies for managing behavioural and psychological symptoms of dementia. Design: As part of a larger study (NINR R01NR014200), four focus groups were conducted with a total of 26 family caregivers of older adults with dementia. Caregivers were asked to describe the strategies they use to manage behavioral and psychological symptoms of dementia. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major categories. Results: Caregivers managed behavioral and psychological symptoms of dementia through (1) modifying interactions within the care dyad (e.g., simplifying communication); (2) modifying the care environment (e.g., using written prompts); (3) activity engagement; (4) humour; (5) self-care; and (6) social support. Conclusion: Family caregivers manage behavioural and psychological symptoms of dementia using strategies to minimise stress and address the needs of both care partners. Caregivers’ own accounts of these approaches reveal a window into their everyday management of difficult behaviours. The present findings generate key information for routine clinical care and targeted interventions to promote caregiver well-being.
(Edited publisher abstract)
International Journal of Nursing Studies, 109, 2020, p.103640.
Publisher:
Elsevier
Background: Refusals of care in dementia are common and can create difficult situations for caregivers. Little is known about the best way to manage them. Aim: To identify possible strategies and interventions to reduce or cope with refusals of care in dementia, and determine the evidence for these. Methods: This study searched MEDLINE, CINAHL, PsycINFO, EMBASE, AMED and Cochrane Central Register
(Edited publisher abstract)
Background: Refusals of care in dementia are common and can create difficult situations for caregivers. Little is known about the best way to manage them. Aim: To identify possible strategies and interventions to reduce or cope with refusals of care in dementia, and determine the evidence for these. Methods: This study searched MEDLINE, CINAHL, PsycINFO, EMBASE, AMED and Cochrane Central Register of Controlled Trials databases August 2018, with an updated search August 2019. An additional lateral search was conducted. Two researchers screened all records for potential eligibility and quality. Narrative synthesis was used to combine the findings. Results: Out of the 5953 records identified, 36 articles, relating to 30 studies, met the eligibility criteria. Twenty-eight of the studies (93%) were set in long-term care facilities, one in a psychogeriatric unit and one with community dwelling people. Fourteen out of the 30 studies focussed on general or mixed care activities, 8 bathing, 4 mealtimes, 2 medication administration, and 2 mouth care. Strategies or interventions identified as potential ways to reduce refusals included: music interventions, interaction and communication style, caregiver approach, bathing techniques, abilities focussed approaches, distraction approaches, and video-simulated presence of a loved one. There was most evidence for music interventions and different bathing techniques, and interaction and communication styles were associated with reduced refusals. There was no evidence that slow-stroke massage (mixed care activities) or aromatherapy (mixed care activities and medication administration) reduced refusals of care. Conclusions: Some non-pharmacological interventions can reduce, but not eliminate, refusals of care, such as playing music during care or communicating positively without using elderspeak. More research evidence is needed to underpin strategies identified as encouraging such as Namaste Care or distraction techniques. Future research should address gaps identified such as, the absence of research examining non-pharmacological interventions for refusals of care in hospital settings and in community settings with home-care workers, and the limited research involving family carers.
(Edited publisher abstract)
Subject terms:
intervention, dementia, behaviour, service uptake, activities of daily living, systematic reviews, behaviour problems;
NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
Publisher:
National Institute for Health Research
Publication year:
2019
Place of publication:
London
Poor understanding amongst healthcare staff of how to care for people with dementia often leads to frustration and resistance to some aspects of care. This NIHR Signal looks at the results of a NIHR-funded study which focussed on interactions at the hospital bedside to gain a better understanding of when refusal of care occurs and how clinical teams respond. Five acute hospitals participated from...
(Edited publisher abstract)
Poor understanding amongst healthcare staff of how to care for people with dementia often leads to frustration and resistance to some aspects of care. This NIHR Signal looks at the results of a NIHR-funded study which focussed on interactions at the hospital bedside to gain a better understanding of when refusal of care occurs and how clinical teams respond. Five acute hospitals participated from across England and Wales. Observations were conducted at the bedside and focussed on everyday care, medication rounds and mealtimes within 10 wards regularly admitting people with dementia for acute conditions. The results confirmed that people living with dementia are often resistant to care in acute hospital settings. Behaviour included wandering in wards, pulling out equipment or refusing food or medicines. Typical staff strategies such as repeating instructions or attempting to contain patients often reinforced cycles of stress and anxiety. The study found that small interventions that are easy to implement had potential to change ingrained ward behaviour and strengthen staff understanding and care of patients with dementia.
(Edited publisher abstract)
Subject terms:
dementia, hospitals, intervention, wandering, behaviour, patients, dignity, health professionals, health care, non-compliant behaviour;
Dementia: the International Journal of Social Research and Practice, 18(4), 2019, pp.1373-1392.
Publisher:
Sage
Objectives: Literature regarding Montessori-based activities with older adults with dementia is fairly common with early stages of dementia. Conversely, research on said activities with individuals experiencing late-stage dementia is limited because of logistical difficulties in sampling and data collection. Given the need to understand risks and benefits of treatments for individuals with late...
(Edited publisher abstract)
Objectives: Literature regarding Montessori-based activities with older adults with dementia is fairly common with early stages of dementia. Conversely, research on said activities with individuals experiencing late-stage dementia is limited because of logistical difficulties in sampling and data collection. Given the need to understand risks and benefits of treatments for individuals with late-stage dementia, specifically regarding their mental and behavioural health, this study sought to evaluate the effects of a Montessori-based activity program implemented in a long-term care facility. Method: Utilizing an interrupted time series design, trained staff completed observation-based measures for 43 residents with late-stage dementia at three intervals over six months. Empirical measures assessed mental health (anxiety, psychological well-being, quality of life) and behavioural health (problem behaviours, social engagement, capacity for activities of daily living). Results: Group differences were observed via repeated measures ANOVA and paired-samples t-tests. The aggregate, longitudinal results—from baseline to final data interval—for the psychological and behavioural health measures were as follows: problem behaviours diminished though not significantly; social engagement decreased significantly; capacities for activities of daily living decreased significantly; quality of life increased slightly but not significantly; anxiety decreased slightly but not significantly; and psychological well-being significantly decreased. Conclusion: Improvements observed for quality of life and problem behaviours may yield promise for Montessori-based activities and related health care practices. The rapid physiological and cognitive deterioration from late-stage dementia should be considered when interpreting these results.
(Edited publisher abstract)
Subject terms:
health, outcomes, dementia, long term care, mental health, behaviour, behaviour problems, therapy and treatment;
Dementia: the International Journal of Social Research and Practice, 18(4), 2019, pp.1479-1491.
Publisher:
Sage
Aim: The present study aimed to explore the impact that changes in behavioural symptoms of people living with dementia have on professional caregiver and resident relationships. Method: A total of 21 interviews were carried out with professional caregivers of people living with dementia. A grounded theory approach was used to investigate everyday experiences of provision of professional care...
(Edited publisher abstract)
Aim: The present study aimed to explore the impact that changes in behavioural symptoms of people living with dementia have on professional caregiver and resident relationships. Method: A total of 21 interviews were carried out with professional caregivers of people living with dementia. A grounded theory approach was used to investigate everyday experiences of provision of professional care in dementia settings, focussing specifically on the effect of behavioural change on such relationships. Results: A core category emerged from this analysis: ‘Developing behaviour in dementia impacts relationships on a personal and professional level’. Discussion: Professionals have recognized as part of their everyday practice an eventual deterioration in relationships between themselves as professional caregivers and the residents, but also between the residents and their family members and among residents themselves. Importantly, understanding patients’ behaviour and behavioural change was identified as a crucial factor to achieve and sustain good relationships between professionals and residents suffering with dementia.
(Edited publisher abstract)
Australasian Journal on Ageing, early cite 26 March 2019, Online only
Publisher:
John Wiley and Sons
Objective: To summarise the evidence regarding the impact of individualised music listening on persons with dementia. Methods: Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non–music‐based...
(Edited publisher abstract)
Objective: To summarise the evidence regarding the impact of individualised music listening on persons with dementia. Methods: Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non–music‐based interventions. Results: Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. Conclusions: The limited evidence suggests individualised music listening has comparable efficacy to more resource‐intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.
(Edited publisher abstract)
CHOI Scott Seung W., BUDHATHOKI Chakra, GITLIN Laura N.
Journal article citation:
International Journal of Geriatric Psychiatry, 34(7), 2019, pp.966-973.
Publisher:
Wiley
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two...
(Edited publisher abstract)
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.
(Edited publisher abstract)
Subject terms:
dementia, outcomes, carers, aggression, depression, agitation, behaviour, service uptake;